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Anterior circulation ischaemic stroke with large vessel occlusion — RCPSC EM MCQ

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HardNeurological emergenciesAnterior circulation ischaemic stroke with large vessel occlusionRCPSC EM

CTAS 2: A 71-year-old develops aphasia and right hemiplegia 90 minutes before arrival. Vitals are BP 178/96, HR 88, glucose 6.2 mmol/L, NIHSS 18. Non-contrast CT shows no haemorrhage; CTA shows proximal left M1 occlusion. The patient was independent at baseline. What is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Start thrombolysis assessment and arrange endovascular stroke transfer

Disabling stroke within the thrombolysis window plus M1 occlusion requires parallel IV thrombolysis eligibility assessment and urgent endovascular-capable pathway activation.

Reference: Canadian Stroke Best Practices; Royal College EM Objectives